基于中心静脉-动脉血二氧化碳分压差及乳酸清除率的早期个体化液体复苏策略在脓毒性休克患者中的疗效研究  

A study on the efficacy of early individualized liquid resuscitation strategy based on P(cv-a)CO_(2) and lactate clearance rate in patients with septic shock

作　　者：顾晓蕾 庾胜 龚菊 李斌[1] 单巍 GU Xiaolei;YU Sheng;GONG Ju;LI Bin;SHAN Wei(Department of Emergency,Affiliated Changshu Hospital of Nantong University,Changshu,Jiangsu,215500,China)

机构地区：[1]南通大学附属常熟医院急诊医学科,江苏常熟215500

出　　处：《临床急诊杂志》2024年第7期343-347,共5页Journal of Clinical Emergency

基　　金：常熟市科技计划(社会发展)项目(No:CS202240);常熟市第二人民医院院级科技计划项目(No:CSEY2021061);常熟市科技发展计划(社会发展)项目(No:CS202028)。

摘　　要：目的:研究基于中心静脉-动脉血二氧化碳分压差[P(cv-a)CO_(2)]及乳酸清除率的24 h内个体化液体复苏策略对脓毒性休克患者的疗效。方法:对2021年7月—2023年6月入住南通大学附属常熟医院ICU治疗的83例脓毒性休克患者进行前瞻性研究。根据初始液体复苏3 h后不同液体复苏治疗方案分为个体化液体复苏组及常规治疗组。比较两组心率、平均动脉压、乳酸、P(cv-a)CO_(2)、SOFA评分、APACHEⅡ评分、去甲肾上腺素用量、住ICU天数、住院天数等参数的差异,通过Kaplan-Meier生存曲线描述两组患者28 d生存率,使用log-rank检验比较组间生存率的差异。结果:两组患者入组时心率、平均动脉压、初始乳酸值差异无统计学意义,24 h的补液量个体化液体复苏组稍低于常规治疗组,个体化液体复苏组APACHEⅡ评分的改善值高于常规治疗组,两组28 d生存率无显著差异。结论:在脓毒性休克患者液体复苏早期使用基于P(cv-a)CO_(2)及乳酸清除率的个体化液体复苏策略可减少不必要的液体输注,更好地改善脓毒性休克患者的器官功能障碍,在复苏早期对两者的监测可用于指导脓毒性休克的治疗。Objective To investigate the efficacy of individualized liquid resuscitation strategy based on central venous-arterial carbon dioxide difference(P[cv-a]CO_(2))and lactate clearance rate in patients with septic shock.Methods A prospective study was conducted on 83 patients with septic shock admitted to our ICU for treatment from July 2021 to June 2023.Pstients were divided into individualized liquid resuscitation group and conventional treatment group according to different liquid resuscitation treatment plans after 3 hours of initial liquid resuscitation.The differences in parameters such as heart rate,mean arterial pressure,lactate,P(cv-a)CO_(2),SOFA score,APACHEⅡscore,norepinephrine dosage,ICU stay,and hospital stay were compared between two groups were compared.Kaplan-Meier survival curves were used to describe the 28-day survival rate of the two groups of patients,and the log-rank tests were used to compare the differences in survival rates between groups.Results There was no statistical differences in heart rate,mean arterial pressure,and initial lactate levels between the two groups of patients upon admission.The individualized fluid resuscitation group had slightly lower 24-hour infusion volume than the conventional treatment group.The reduction in APACHEⅡscore in the individualized fluid resuscitation group was higher than that in the conventional treatment group,and there was no significant statistical difference in the 28-day survival rate of the two groups.Conclusion Early use of individualized fluid resuscitation strategies based on P(cv-a)CO_(2) and lactate clearance rate in septic shock patients can lead to less fluid and lower incidence of organ dysfunction.Monitoring both in the early stages of resuscitation can be used to guide the treatment of septic shock.

关 键 词：脓毒性休克 中心静脉-动脉血二氧化碳分压差 乳酸清除率 液体复苏 

分 类 号：R631[医药卫生—外科学]